Comparing jurisdiction-specific pharmaco-economic evaluations using medical purchasing power parities

Figures & data

Figure 1. Flowcharts of pathways with application to estimating the cost of gemcitabine using the Gharaibeh 2018 UK study as a basis.

Figure 2. Equations for converting costs to 2019 US$ for both pathways with application to estimating the cost of gemcitabine using the Gharaibeh 2018 UK study as a basis.

Table 1. Overview of studies included.

Study	Country	Year	Disease	Regimen for Nab-P + Gem	Regimen for Gem	Outcomes	Discount rate	Perspective	Model	Funding	Reference
Carrato et al.	Spain	2014	Metastatic pancreatic cancer	IV infusion Nab-P 125 mg/m^2 + Gem 1,000 mg/m^2 weekly for 3 weeks every 4 weeks	IV infusion Gem 1,000 mg/m^2 weekly for 7 weeks every 8 weeks for the first cycle and 3 weeks every 4 weeks for subsequent cycles	LY, QALY, ICER, ICUR	3%	Payer; Spanish National Health System	Markov	Celgene	^22
Coyle et al.	Canada	2016	Advanced pancreatic cancer or adenocarcinoma	IV Nab-P 125 mg/m^2 + Gem 1,000 mg/m^2 once weekly for every 3 of 4 weeks	IV Gem 1,000 mg/m^2 once weekly for 7 of 8 weeks for the first cycle, then 3 of 4 weeks	LY, QALY, ICER	5%	Payer; Canadian public health	Markov cohort	Independent	^20
Fragoulakis et al.	Greece	2014	Metastatic pancreatic cancer	NA	NA	LY, QALY	3.5%	Payer; National Health System	Markov	NA	^23
Gharaibeh et al. UK 2015	UK	2015	Metastatic pancreatic cancer	IV Nab-P 125 mg/m^2 + Gem 1,000 mg/m^2 on days 1, 8, and 15, and repeated on 28-day cycle	IV Gem 1,000 mg/m^2 weekly for 7 weeks and then on days 1, 8, and 15 every 28 days	LY, QALY, ICER, ICUR	3.5%	Third party payer in UK	Markov	Independent	^24
Gharaibeh et al. UK 2018	UK	2018	Metastatic pancreatic cancer	–	–	LY, QALY, ICER, ICUR	3.5%	Payer	Markov	Independent	^25
Gharaibeh et al. US 2016	US	2016	Metastatic pancreatic cancer	–	–	LY, QALY, ICER, ICUR	3%	Payer	State-transition	Independent	^2
Gharaibeh et al. US 2018	US	2018	Metastatic pancreatic cancer	–	–	LY, QALY, ICER, ICUR	3%	Payer	Markov	Independent	^26
Kumimoto et al.	Japan	2017	Metastatic pancreatic cancer	IV Nab-P 125 mg/m^2 followed by Gem 1,000 mg/m^2 on days 1, 8, and 15 every 4 weeks	IV Gem 1000 mg/m^2 on days 1, 8, and 15 every 4 weeks	Median Survival Time (months), Cost effectiveness ratio	NA	NA	NA	NA	^3
Lazzaro et al.	Italy	2017	Previously untreated metastatic pancreatic cancer	IV Nab-P 125 mg/m^2 + Gem 1,000 mg/m^2 on days 1, 8, and 15 every 4 weeks	IV Gem alone 1,000 mg/m^2 weekly for 7 out of 8 weeks (cycle 1) and then on days 1, 8, and 15 every 4 weeks until progression	LY, QALY, ICER, ICUR	3%	Payer; Italian National Health Service	Markov model	Celgene	^27
Stainthorpe et al.	UK	2014	Previously untreated metastatic pancreatic cancer	IV Nab-P 125 mg/m^2 over 30–40 min followed by Gem 1,000 mg/m^2 over 30 min on days 1, 8, and 15 of 28-day cycle	IV Gem 1,000 mg/m^2 over 30 min on days 1, 8, and 15 of each 28-day cycle	QALY, ICUR	3.5%	Societal; NHS and personal social services	Markov model	Celgene	^28
Stetka et al.	Slovakia	2015	Unresectable metastatic pancreatic cancer	–	–	LY, QALY, ICER	5%	Payer; Slovak health insurance	Markov model	NA	^29

– Indicates that doses are based on clinical trials.

Abbreviations. Nab-P, nab-paclitaxel; Gem, gemcitabine; NA, not available; LY, life year; QALY, quality adjusted life year; ICER, incremental cost effectiveness ratio; ICUR, incremental cost utility ratio.

Table 2. Source of cost inputs.

Study	Cost input for chemotherapy
Carrato et al.^22	Portalfarma; General Council of Official Colleges of Pharmacists in Spain
Coyle et al.^20	Ontario public drug programs
Fragoulakis et al.^23	Greece hospitals
Gharaibeh et al. UK 2015^24	British National Formulary
Gharaibeh et al. UK 2018^25	British National Formulary 2017
Gharaibeh et al. US 2016^2	REDBOOK 2015
Gharaibeh et al. US 2018^26	REDBOOK 2017
Kumimoto et al.^3	Insurance Drug Encyclopedia
Lazzaro et al.^27	Ex-factory price (manufacturer price)
Stainthorpe et al.^28	Clinical trial CA046 (A confidential Department of Health PAS discount was applied to the cost of Nab-P)
Stetka et al.^29	NA

Abbreviations. Nab-P, nab-paclitaxel; NA, not available.

Table 3. Costs inputs.

Study	Country	Year of cost reported	Currency	Cost of nab- Nab-P + Gem	Cost of Gem
Carrato et al.^22	Spain	2014	€ Euro	16,885.00	10,408.00
Coyle et al.^20	Canada	2016	$ Canada	54,043.00	20,460.00
Fragoulakis et al.^23	Greece	2014	€ Euro	15,628.00	8,284.00
Gharaibeh et al. UK 2015^24	UK	2015	£ Pound	9,314.00	3,848.00
Gharaibeh et al. UK 2018^25	UK	2017	£ Pound	20,806.00	10,326.00
Gharaibeh et al. US 2016^2	US	2015	$ US	49,007.00	23,042.00
Gharaibeh et al. US 2018^26	US	2017	$ US	56,102.00	23,311.00
Kumimoto et al.^3	Japan	2017	¥ Yen	4,802,063.60	540,091.40
Lazzaro et al.^27	Italy	2017	€ Euro	19,002.03	11,919.34
Stainthorpe et al.^28	UK	2014	£ Pound	31,109.80	17,214.33
Stetka et al.^29	Slovak	2015	€ Euro	9,912.13	3,969.52

Abbreviations. mPPP, medical purchasing power parities; Nab-P, nab-paclitaxel; Gem, gemcitabine.

Table 4. Cost calculations.

Study	mPPP in each country (nearest reported year)	Local currency units to US$ 2019	Cost of Nab-P + Gem converted to US$ 2019 with mPPP→F/X	Cost of gem converted to US$ 2019 with mPPP→F/X	Cost difference in US$ 2019 with mPPP→F/X	Local Currency units to US$ in reported currency year in their respective studies	Cost of Nab-P + Gem converted to US$ 2019 with F/X→mPPP	Cost of gem converted to US$ 2019 with F/X→mPPP	Cost difference in US$ 2019 with F/X→mPPP
Carrato et al.^22	446.1→525.2	0.6	33,135.37	20,424.81	12,710.56*	0.8	24,848.69	15,316.86	9,531.83
Coyle et al.^20	835.1→879.3	1.2	47,420.78	17,952.91	29,467.87^#	1.3	43,771.83	16,571.46	27,200.37
Fragoulakis et al.^23	542.5→594.5	0.6	28,542.71	15,129.75	13,412.96*	0.8	21,407.48	11,347.55	10,059.93
Gharaibeh et al. in UK 2015^24	467.5→526.2	0.7	14,976.57	6,187.44	8,789.13*	0.7	14,976.57	6,187.44	8,789.13*
Gharaibeh et al. in UK 2018^25	481.5→526.2	0.7	32,485.38	16,122.47	16,362.91*	0.8	28,421.90	14,528.19	13,893.71
Gharaibeh et al. in US 2016^2	1,176.7→1,228.7	1	51,170.54	24,059.25	27,111.29*	1	51,170.54	24,059.25	27,111.29*
Gharaibeh et al. in US 2018^26	1,202.6→1,228.7	1	57,315.95	23,815.41	33,500.54*	1	57,315.95	23,815.41	33,500.54*
Kumimoto et al.^3	–	101.5	47,310.97	5,321.10	41,989.87†	112.1	42,837.32	4,817.94	38,019.38
Lazzaro et al.^27	598.6→655.3	0.7	29,717.20	18,640.61	11,076.59^#	0.9	23,113.25	14,498.17	8,615.08
Stainthorpe et al.^28	475.7→526.2	0.7	49,156.58	27,200.35	21,956.23*	0.6	57,353.99	31,408.15	25,945.83
Stetka et al.^29	553.3→546.5	0.5	19,579.28	7,840.93	11,738.35*	0.9	10,878.12	4,356.37	6,521.75

^#Indicates 2019 US$; * indicates 2018 US$; † indicates 2017 US$; – indicates there was no reported medical purchasing power parities conversion from the reported year to the nearest year.

Abbreviations. mPPP, medical purchasing power parities; Nab-P, nab-paclitaxel; Gem, gemcitabine; mPPP→F/X, defined as calculations through mPPP then currency exchange; F/X→mPPP, defined as calculations through currency exchange then mPPP.

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